后腹腔镜保留肾单位手术治疗肾癌(附9例报告)

目的：探讨后腹腔镜保留肾单位治疗肾癌的手术方法及其临床效果。方法：采用后腹腔镜保留肾单位手术治疗肾癌共9例,经病理确诊为肾透明细胞癌6例,肾乳头状腺癌3例。结果：9例手术均获成功。手术时间120～160min,平均130min。住院时间7～10天。术后无并发症。术后随访1～18个月,无肿瘤复发及转移,无切口肿瘤种植。结论：后腹腔镜保留肾单位手术治疗肾癌具有创伤小、解剖清晰、术中出血少、术后恢复快等优点。     

Evaluation of the Seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification

BACKGROUND:

The seventh TNM staging system for gastric cancer of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) had a more detailed classification than the sixth TNM staging system for both the tumor (T) and lymph nodes (N). The authors compared survival rates assessed by the seventh staging system with those by the sixth system.

METHODS:

The authors analyzed the prospectively collected database on patients with gastric cancer who underwent surgery at Seoul National University Hospital between 1986 and 2006, and calculated the survival rates of 9998 cases with primary cancer, R0 resection, and >14 retrieved lymph nodes.

RESULTS:

The 5‐year cumulative survival rates (5YSR) according to the seventh edition T or N classifications were significantly different. The 5YSR according to seventh edition of the TNM staging system were 95.1% (stage IA), 88.4% (stage IB), 84.0% (stage IIA), 71.7% (stage IIB), 58.4% (stage IIIA), 41.3% (stage IIIB), and 26.1% (stage IIIC), which were significantly different from each other. The 5YSR of the seventh edition T2 and T3 classifications had significant differences in patients with every N classification, and the 5YSR of seventh edition N1 and N2 classifications had significant differences in T2 patients, T3 patients, and T4 patients. Each stage in the sixth edition was divided into the seventh edition stage with different survival rates. In addition, the number of homogenous groupings in seventh edition TNM stages was increased from 1 to 2.

CONCLUSIONS:

The seventh system provided a more detailed classification of prognosis than the sixth system, especially between T2 and T3 tumors and N1 and N2 tumors, although further studies were found to be needed for the N3a and N3b classification. Cancer 2010. © 2010 American Cancer Society.     

肺错构瘤的诊断与治疗

 本文报告了肺错构瘤30例，男女之比为1. 7 : 1，平均年龄46. 9岁，病史平均7. 9个月.40%的病人无症状，其他病人临床症状少而轻，主要表现为咳嗽、胸痛、疾中带血和气短oX线表现为圃形、类圆型阴影，13. 3%有分叶，10.0%有钙化.全组术前确诊率为26. 7%.本文将肺错构瘤分为三种类型:肺内型25例占83.4%,腔内型4例占13. 3%，发型1例占3.3%.本文对肺错构瘤的病因、分类、诊断、鉴别诊断和治疗进行了讨论.     

甲状腺乳头状癌颈部的处理

目的 探讨甲状腺乳头状癌颈部处理的最佳方案。方法 总结１９６５年１月～１９８７年１月４２４例甲状腺乳头状癌的临床资料,根治原发灶的同时,对颈部淋巴结阳性（Ｎ＋）患者进行颈清扫术,对颈部淋巴结阴性（Ｎ０）患者进行观察,待出现颈淋巴结转移后再行治疗性颈清扫术。所有患者均随访１０年以上。结果 ２５８例颈部Ｎ＋患者的５,１０年生存率分别为８４．３％和８０．４％,而１６６例Ｎ０患者的５,１０年生存率分别为９     

胸腔镜治疗食管癌术后乳糜胸

目的：探讨胸腔镜手术在食管癌手术后乳糜胸治疗中的作用。方法2012年1月至2013年12月,应用胸腔镜经右胸入路行胸导管结扎治疗食管癌术后并发乳糜胸16例。结果16例患者均在胸腔镜下完成手术。手术时间40～90 min,平均65 min。术后引流时间4～9天,平均引流时间5．5天。术后无严重并发症,随访6个月无复发。结论胸腔镜治疗食管癌术后乳糜胸是一种安全、有效的治疗方法。手术后并发乳糜胸应尽早行胸腔镜手术干预,有助于患者的早日康复,减少住院时间。     

经腹手术治疗贲门癌临床分析

目的 探讨经腹手术治疗贲门癌的临床价值.方法 回顾性分析55例经腹手术治疗贲门癌患者的临床资料.结果 手术根治率、围术期死亡率和呼吸道并发症发生率分别为69.1%、0%和7.3%.结论 经腹食管胃吻合术既能切除足够的食管和扩大淋巴结的清除范围,又可减少肺部并发症的发生,对高龄或心肺功能不全患者是一种合适的手术方式.     

快速康复外科联合腹腔镜应用于远端胃癌根治术的安全性及可行性分析

目的 探讨快速康复外科联合腹腔镜应用于远端胃癌根治术的安全性及可行性.方法 随机选取行远端胃癌根治手术治疗的60例患者,根据手术方式及围手术期处理方案随机分为4组,15例实施传统的开腹远端胃切除术(第1组);15例实施快速康复外科开腹远端胃切除术(第2组);15例实施传统的腹腔镜辅助远端胃切除术(第3组);15例实施快速康复外科腹腔镜辅助远端胃切除术(第4组).并将这4组远端胃癌患者的手术情况、临床特征、血清白蛋白水平及术后复发等情况进行分析对比.结果 通过对比分析,第1组无论在排气时间、术后住院时间均长于其他3组,在术后血清水平指标上均低于其他3组;第4组的术后血清水平最高,在排气时间及术后住院治疗时间方面相对较低.结论 快速康复外科联合腹腔镜应用于远端胃癌根治术,可以改善患者的营养状态,促进患者术后早期胃肠功能恢复,缩短住院时间,加快患者康复,因此与传统的手术处理、腹腔镜辅助远端胃癌根治术相比,是安全、有效、可行的.     

原发性结直肠恶性淋巴瘤20例临床分析

目的掌握原发性结直肠恶性淋巴瘤的诊断和治疗。方法回顾性分析２０例原发性结直肠恶性淋巴瘤的临床病理特点。结果病变主要发生在右半结肠，以腹块（８５％）、腹痛（７５％）、体重下降（４５％）以及血便（４０％）、腹胀（３０％）等为主要特点。１例为霍奇金淋巴瘤；１９例为非霍奇金淋巴瘤，其中１８例为弥散型Ｂ细胞型。治疗宜采用手术、化疗、放疗等的综合治疗方法。结论临床、影像学和内窥镜检查结合可提高诊断率；根治切除者预后较好；规范性化疗可以提高远期疗效。     

O6-methylguanine DNA-methyltransferase methylation status can change between first surgery for newly diagnosed glioblastoma and second surgery for recurrence: clinical implications

O⁶-methylguanine DNA-methyltransferase (MGMT) promoter methylation status is a prognostic factor in newly diagnosed glioblastoma patients. However, it is not yet clear whether, and if so how, MGMT methylation status may change. Moreover, it is unknown whether the prognostic role of this epigenetic feature is retained during the disease course. A retrospective analysis was made using a database of 614 glioblastoma patients treated prospectively from January 2000 to August 2008. We evaluated only patients who met the following inclusion criteria: age ≥18 years; performance status 0-2; histological diagnosis of glioblastoma at both first and second surgery for recurrence; postoperative treatment consisting of: (i) radiotherapy (RT) followed by adjuvant temozolomide (TMZ) until 2005 and (ii) TMZ concurrent with and adjuvant to RT after 2005; a time interval ≥3 months between first and second surgery. MGMT status was evaluated at first and second surgery in all 44 patients (M:F 32:12, median age: 49 years, range: 27–67 years). In 38 patients (86.4%), MGMT promoter status was assessable at both first and second surgery. MGMT methylation status, changed in 14 patients (37%) of second surgery samples and more frequently in methylated than in unmethylated patients (61.5% vs 24%, P = .03). The median survival was significantly influenced only by MGMT methylation status determined at first surgery (P = .04). Significant changes in MGMT methylation status during the course of GBM occur more frequently in MGMT methylated than unmethylated cases. MGMT methylation status determined at first surgery appears to be of prognostic value; however, it is not predictive of outcome following second surgery.     

Ⅰ期非小细胞肺癌淋巴结清扫中胸腔镜手术的效果

目的探讨胸腔镜下Ⅰ期非小细胞肺癌（NSCLC）根治术中淋巴结清扫的效果。方法收集经胸腔镜手术治疗74例（胸腔镜组）及开胸手术治疗80例（开胸组）的Ⅰ期NSCLC患者的临床资料,比较分析2组淋巴结清扫数目的差异,同时比较2组术中出血量、术后胸腔引流量、声音嘶哑、心肺总并发症的差异。结果胸腔镜组在双侧N2淋巴结清扫的数量高于开胸组（P〈0．05）;2组双侧N1淋巴结清扫数量差异无统计学意义（P〉0．05）;2组术中出血量、术后胸腔引流量、声音嘶哑发生率及心肺总并发症发生率差异均无统计学意义（P〉0．05）。结论在Ⅰ期NSCLC根治术中,胸腔镜下系统性淋巴结清扫在技术上符合肿瘤外科原则,优于开胸手术。